What To Do After Experiencing Recurrent Pregnancy Loss

What is Recurrent Pregnancy Loss?

The loss of a pregnancy is heartbreaking and recurrent pregnancy loss can feel unbearable to those who are dreaming of becoming parents. About 15-20% of all clinically recognised pregnancies end in miscarriage. From that original number, only about 1% will experience subsequent miscarriage. 

RPL is defined as the loss of two or more clinically recognised pregnancies. For those experiencing RPL, talking with your doctor or a fertility specialist can help you narrow down the possible causes of miscarriage and understand your potential options for moving forward and growing your family.

What Causes Recurrent Pregnancy Loss?

After experiencing multiple miscarriages, there’s no doubt you are searching for an answer as to “why?” It can be hard to know what to do next as you grieve your recurrent pregnancy loss and try to rationalise what’s happened. It’s important to remember, it is not your fault. Many causes of miscarriage are out of our control. 

Understanding some of the common causes of miscarriage can be a great first step to finding a little peace and determining the right next step for you and your growing family. 

Comprehensive fertility testing can give physicians a comprehensive picture of your reproductive health and help identify any abnormalities that may be causing the miscarriages.

Common Causes and Testing

Recurrent pregnancy loss (RPL) can be caused by a number of things, most of which are ultimately out of your control. Simple fertility tests, such as blood tests and ultrasounds, can be used to narrow down the potential causes of RPL:

• Genetics: Balanced translocations, where a piece of one chromosome breaks off and attaches to another chromosome, are often identified in individuals with a history of recurrent miscarriage. While the individual with the translocation is healthy, the sperm or eggs created from the person often have extra or missing genetic information, which results in recurrent pregnancy loss. Balanced translocations can be identified with a simple blood test on both the sperm and egg provider.
• Anatomic: Abnormalities or deformities in reproductive anatomy can make it difficult for an embryo to implant and grow in a healthy way. Deformities in uterine anatomy can create a higher risk of miscarriage, due to inadequate support required for the pregnancy or interference with the pregnancy in other ways. This cause can be identified with an ultrasound, saline infusion sonohysterogram (SIS), or hysterosalpingogram (HSG) to evaluate the shape and size of the uterus and also look for scarring, fibroids, and other abnormalities.
• Autoimmune: Autoimmune conditions can affect a healthy pregnancy, as well. Antiphospholipid Syndrome, or APS, is a rare autoimmune condition where the immune system attacks phospholipid-bound proteins, a necessary part of the human cell, in the blood cells and blood vessels. The presence of these antibodies can impair the embryo’s ability to implant into the uterus and may also cause blood clots in the tiny vessels required for the embryo to feed and grow.
• Infectious: Chronic endometritis is a localised inflammatory condition of the inner lining of the uterine cavity. This condition is present in 10-11% of our population, presenting even more frequently in those who are facing infertility or recurrent miscarriage. Chronic endometritis can be caused by common bacteria and frequently has no symptoms. The presence of chronic endometritis can alter the immune cells and modify a series of genes that are involved in embryo implantation, causing a miscarriage.
• Hormonal: Abnormal levels of a number of different hormones can disrupt the reproductive system and lead to recurrent pregnancy loss. Just like genetic testing, testing for hormonal abnormalities can be done with a simple blood test. 
• Reproductive Age: Couples and individuals are choosing to wait longer than ever to start their family for a variety of reasons such as professional, family, or health reasons. While we support the choice to build your family on your timeline, our biology, unfortunately, has not caught up. As the age of the egg provider increases, so does the risk of chromosomal abnormal eggs and chromosomal errors within the embryo. 

What Are My Treatment Options for RPL?

Based on your diagnosis, there are a variety of ways you can move forward. Many of the identifiable conditions that cause recurrent pregnancy loss can be managed. Treatments can include:  

• Genetics: For individuals with chromosome abnormalities, such as a balanced translocation,  the use of IVF with preimplantation genetic testing can improve outcomes by allowing embryos with the correct number of chromosomes to be identified and then transferred into the uterus.
• Anatomic: If anatomic abnormalities are identified, such as fibroids or a uterine septum, surgical correction can potentially increase the chances for a healthy and successful pregnancy. 
• Autoimmune: Autoimmune conditions can be addressed with a range of interventions, including the use of blood thinners to help the tiny embryo implant and grow normally.
• Hormonal: Hormonal abnormalities can often be corrected using supplemental medications to normalise the hormone profile.
• Reproductive Age: For egg providers whose egg health and quantity is declining, there are options to optimise chances of a successful pregnancy. By going through IVF, we can collect a number of eggs at once and ensure that they meet with sperm. Testing of the resulting embryos with preimplantation genetic testing, can then identify chromosomal abnormalities that might prevent successful implantation and growth. 

When there is a non-modifiable medical cause of recurrent pregnancy loss and pregnancy would be unlikely or even unsafe for the carrier, gestational surrogacy can be a great option to help couples and individuals grow their family. 

We also know that losing a pregnancy has a profound emotional impact. As a result, patients may choose to partner with a surrogate when the emotional toll of the risk of experiencing another failed pregnancy feels too high to try and carry again on one’s own. 

There are many individuals who feel passionately about helping other families grow, whether it’s through egg donation, sperm donation, or surrogacy. With many robust donor and surrogacy programs out there and more surrogacy friendly laws being passed every year, the options for family building through third party reproduction can bridge the gap to help you realise your dream of parenthood.

While most causes of recurrent pregnancy loss are out of our control, there are a few things we can do now to help increase our chances of conceiving and carrying a healthy pregnancy. Try taking the following steps to improve your lifestyle for fertility:

• Maintain a BMI between 18-35
• Quit smoking, anything! This includes both tobacco and marijuana 
• Limit caffeine intake to 250mg/day
• Minimise environmental exposures to Endocrine Disrupting Chemicals like phthalates and bisphenols:
  • Store food and heat food in glass container
  • Avoid processed foods
  • Cookware that does not contain a non-stick surface, such as teflon. Consider cast iron or ceramic coatings instead

Related Article – Baby Loss – Grief, Coping Mechanisms and Pregnancy after Loss

Some OB/GYN’s are comfortable evaluating and treating recurrent pregnancy loss, but many prefer to send their patients to a Reproductive Endocrinologist (REI) or fertility specialist. While many people see fertility clinics as a source for care in cases where individuals or couples cannot conceive a pregnancy, they also provide evaluation and care for those who are having difficulty staying pregnant. Recurrent pregnancy loss is a unique condition, separate from infertility, which warrants an evidence-based evaluation to help optimise outcomes.  

With specialised training in the management of RPL, fertility specialists have the ability to do intensive early pregnancy monitoring with weekly ultrasounds for viability and can rapidly respond to patients with bleeding and pain. As they care for a number of patients experiencing RPL, REI’s are more apt to stay up-to-date on current research and technology around RPL evaluation and management.

Because the emotional toll of RPL is so high, patients seeking answers may be convinced to undergo thousands of dollars worth of unnecessary or unproven testing and treatment in an attempt to have a successful pregnancy. The most important thing is to have your evaluation performed by a fertility specialist who is knowledgeable about RPL and has your health and safety, and the health and safety of your pregnancies in mind. Seeing an REI or Fertility Specialist can be a great addition and tool to support your journey to parenthood, in partnership with your OB/GYN or primary care physician.

Related Article – Trying to Conceive and Pregnancy After Baby Loss – Lisa’s Story

Your Journey is Unique

There is no right or wrong path to parenthood and the journey is not always linear. In the end, you have to do what feels right for YOU. Take the time you need to mourn and explore your options for moving forward. Your experiences, your feelings, and your journey are unique to you.  

And remember: you are not alone. There is a community of people who are experiencing similar recurrent pregnancy loss and can provide support and connection during this hard time. Practice self-care and lean on your support system, partner, friends, family, and your care team to help you navigate this fertility journey.

Finding Support at ORM

ORM Fertility clinic has a passionate and robust team of physicians, genetic counsellors, embryologists, mental health counsellors, clinical staff and more that are always here to meet you where you’re at on your path to parenthood. Whether you are in need of basic fertility testing or looking to grow your family through surrogacy, our team of fertility experts is here to help and support you in every step of your journey. 

Check out our website to learn more about our services or attend one of our FREE monthly webinars to learn how ORM Fertility can help you grow your family.

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